A successful scheme for reducing waiting times for arteriovenous fistula formation

Abstract

In a bid to reduce waiting times for arteriovenous fistula (AVF) formation we introduced a scheme whereby nephrologists were able to place patients directly on the waiting list for surgery. This study evaluated the quality of these direct referrals and assessed the reduction in waiting times. Fifty consecutive patients referred directly to the waiting list were compared with 50 patients placed on the waiting list after being assessed in our vascular access clinic. Forty-nine patients from the direct group and 47 patients from the clinic group underwent surgery. In the direct group 39 patients (80%) underwent the same procedure as they had been originally listed for, compared with 39 patients (83%) in the clinic group (p=0.80). A fistula suitable for needling was created in 37 patients (76%) of the direct group and 38 patients (81%) of the clinic group (p=0.62). The median wait from referral to surgery in the direct group was significantly lower than in the clinic group (62 vs.141 days; p<0.0001). This study demonstrates that nephrologists are able to effectively assess select patients for AVF formation. This significantly reduces waiting times for surgery, without an increase in cancelled operations, or a reduction in technical success.